Neonatology
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Review
Monitoring neonatal regional cerebral oxygen saturation in clinical practice: value and pitfalls.
This review focuses on the clinical use of near infrared spectroscopy (NIRS) to assess brain oxygenation by the tissue oxygenation index (TOI), and monitoring regional cerebral oxygen saturation (rScO(2)), cerebral fractional tissue oxygen extraction (cFTOE), which is derived from rScO(2), and systemic oxygen saturation. Its precision and pitfalls are discussed. At this stage, it is clear that NIRS-monitored oxygenation of the brain by rScO(2) or TOI lacks the precision required to be used as a robust quantitative variable to monitor cerebral oxygenation. ⋯ Since neonatal intensive care is for a substantial part 'brain orientated' this approach seems conceivable. This gives rise to the conclusion that NIRS-monitored TOI, rScO(2) and cFTOE increasingly will have a role in clinical practice as semiquantitative indicators of changes in cerebral oxygenation and oxygen extraction. Combination with other (cerebral) parameters such as amplitude-integrated EEG and blood pressure seems promising for further optimization of monitoring the immature brain.
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With current evidence, no specific oxygen concentration can yet be recommended in the resuscitation of the depressed term neonate. ⋯ We have demonstrated the ability to ventilate, create hypoxic stress, and resuscitate neonatal rats. While resuscitation with 21 or 100% oxygen results in a transient increase in oxidative glutathione levels, the oxygen-resuscitated group alone demonstrated a reduction in reduced glutathione 24 h later. Furthermore, these pups can then be returned to their dams for rearing, allowing ongoing evaluation of long-term effects of hypoxia and various modes of resuscitation.
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Review Meta Analysis Comparative Study
Resuscitation of newborn infants with 21% or 100% oxygen: an updated systematic review and meta-analysis.
The issue of whether 21% O(2) is more effective than 100% O(2) for resuscitation of newborn infants remains controversial. ⋯ There is a significant reduction in the risk of neonatal mortality and a trend towards a reduction in the risk of severe hypoxic ischemic encephalopathy in newborns resuscitated with 21% O(2).
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Review Meta Analysis
A systematic review and meta-analysis of a brief delay in clamping the umbilical cord of preterm infants.
The optimal timing of clamping the umbilical cord in preterm infants at birth is the subject of continuing debate. ⋯ The procedure of a delayed cord clamping time of at least 30 s is safe to use and does not compromise the preterm infant in the initial post-partum adaptation phase.
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Nasal continuous positive airway pressure (nCPAP) is an effective treatment of respiratory distress syndrome. Due to long-standing experience of early nCPAP as the primary respiratory support option in preterm infants, this approach is sometimes labeled 'the Scandinavian Model'. Mechanical ventilation is potentially harmful to the immature lungs and cohort studies have demonstrated that centers using more CPAP and less mechanical ventilation have reduced rates of bronchopulmonary dysplasia. ⋯ Surfactant is essential in the treatment of respiratory distress syndrome and has generally been reserved for infants on mechanical ventilation. With the development of INSURE (INtubation SURfactant Extubation), in which surfactant is administered during a brief intubation followed by immediate extubation, surfactant therapy can be given during nCPAP treatment further reducing need for mechanical ventilation. In this review the history, current knowledge and techniques of CPAP and surfactant are discussed.